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Hyperbaric oxygen treatment protocols for mandibular osteoradionecrosis.

C E Wreford-Brown¹, N B Hampson

¹Center for Hyperbaric Medicine, Virginia Mason Medical Center, Seattle, Washington, USA.

Undersea & Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc

|November 19, 2003

Summary

Hyperbaric oxygen (HBO2) is frequently used for mandibular osteoradionecrosis (ORN) in North America. However, current treatment protocols lack standardization, with no evidence favoring one method over another for improved outcomes.

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Area of Science:

Oral and Maxillofacial Surgery
Hyperbaric Medicine
Oncology Rehabilitation

Background:

Osteoradionecrosis (ORN) of the mandible is a significant complication following radiation therapy for head and neck cancers.
Hyperbaric oxygen (HBO2) therapy is a recognized treatment modality for ORN.
Standardization of HBO2 protocols for mandibular ORN is lacking.

Purpose of the Study:

To assess current hyperbaric oxygen (HBO2) treatment practices for mandibular osteoradionecrosis (ORN) in North America.
To identify variations in HBO2 protocols used for treating mandibular ORN.

Main Methods:

A survey was conducted among hyperbaric facilities listed in the 1998 UHMS Chamber Directory.
A high response rate of 99.7% was achieved, with 280 facilities reporting on mandibular ORN treatment.
Data on treatment protocols, pressures, and oxygen breathing times were collected.

Main Results:

A large majority of surveyed North American hyperbaric facilities (280 out of 316) treat or would treat mandibular ORN with HBO2.
Twelve distinct hyperbaric treatment protocols were reported for mandibular ORN.
Approximately 75% of facilities use a protocol of 90 minutes of 100% oxygen at 2.4-2.5 atm abs, while the remainder use alternative protocols.

Conclusions:

Mandibular ORN is commonly managed with HBO2 therapy in North America.
There is significant heterogeneity in the HBO2 treatment protocols employed for mandibular ORN.
Current clinical data do not support the superiority of any single protocol for treating mandibular ORN.